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Individual

MACKENZIE GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ACPNP

Contact information

Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 772-8850
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2414
(207) 662-6006

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
2300770
MA
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP221665
ME

Other

Enumeration date
01/28/2020
Last updated
01/08/2025
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